Delaware Medicaid History and Facts

Initial Medicaid Implementation: Delaware initially implemented its Medicaid program in October of 1966. The state was one of many that lowered eligibility shortly after the program began (originally, eligibility was approximately 150% of the welfare benefit level and that was later reduced to be more in line with existing welfare benefit levels in the state.

Key Medicaid Political Issues: In 1996 the state overhauled its Medicaid program to move the administration to managed care called the Diamond State Health Plan. Under the same reforms, the state expanded coverage for Medicaid to 100% the federal poverty level. The state also made significant investments in cancer screening and treatment with eligibility levels at 600% of poverty for these services. The state has seen reductions in cancer mortality and infant mortality following the changes implemented in 1996, although it’s unclear whether these reductions were due to the policy changes.

Medicaid Expansion Implementation: Delaware expanded Medicaid with the expansion taking effect January 1, 2014. The state has formed a Medicaid buy in study group to look into the possibility of allowing people at higher incomes to purchase Medicaid coverage. The state also is in the process of implementing a waiver to expand coverage to former foster children beyond the required levels under the Affordable Care Act.

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General facts about Delaware Medicaid:

Medicaid program name: Medicaid

CHIP Program name: HealthyKids

Separate or combined CHIP: Combination

Medicaid Enrollment: 239,600 (2016 estimate)

Total Medicaid Spending: $1.9 (FY16 Estimate)

Share of total population covered by Medicaid: 19%

Share of Children covered by Medicaid: 33% (estimate)

Share of Medicaid that is Children and Adults: 83%

Share of Spending on Elderly and people with disabilities: 46%

Share of Nursing Facility Residents covered by Medicaid: 60% (estimate)

FMAP: 54.2%

Expansion state: Yes

Number of people in expansion: 67,900 (2016)

Work Requirement: No

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Connecticut Medicaid History and Facts

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Initial Medicaid Implementation: Connecticut was one of the first states to initially sign on to establish the Medicaid program. The program was established in July of 1966, a year after the passage of the law. By 1969 the state began to implement cuts to the program, likely due in large part to the growth of the nursing home industry following implementation. Nursing facility beds doubled in the state following implementation. While less is written about the early implementation of the state’s Medicaid program, a Hartford hospital claims the first Medicare beneficiary.

Key Medicaid Political Issues: Connecticut has been a leader in expanding coverage. In 2012 the state dropped its managed care contracts after using managed care for the adult population for 15 years. This is especially notable considering the high prevalence of insurance companies located in Connecticut.

Medicaid Expansion Implementation: Connecticut was one, and the first, of several states to take advantage of the early expansion program offered under the Affordable Care Act. The state created an eligibility group for certain low-income childless adults, many of whom were previously eligible for an existing program (SEGA) into Medicaid. Approximately 75,000 people making below 56% of poverty were eligible to enroll in the early expansion. The state has had a series of policies that connect incarcerated individuals with Medicaid expansion.

General facts about Connecticut Medicaid:

Medicaid program name: HUSKY Health

CHIP Program name: HUSKY B

Separate or combined CHIP: Separate CHIP

Medicaid Enrollment: 771,600 (2017)

Total Medicaid Spending: $7.9 billion (FY 2016)

Share of total population covered by Medicaid: 19% (2015)

Share of Children covered by Medicaid: 33% (estimate)

Share of Medicaid that is Children and Adults: 76%

Share of Spending on Elderly and people with disabilities: 57%

Share of Nursing Facility Residents covered by Medicaid: 66% (estimate)

FMAP: 50%

Expansion state: Yes

Number of people in expansion: 207,600

Work Requirement: No (Proposed in the legislature in March of 2018)

Colorado Medicaid History and Facts

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Initial Medicaid Implementation: Colorado initially established its Medicaid program in 1969. Colorado has seen significant growth in economic development and growth in the state government over the first thirty years of their Medicaid program. Similarly, the legislature had begun to professionalize during the later half of the 20th century with it moving from a biannual legislature to an annual legislature.

Key Medicaid Political Issues: Colorado was an early adopter in providing home and community-based services, beginning this program in 1985. The state’s participation with managed care with participation increasing and decreasing over time. During the economic downturn in the early 2000’s the state temporarily eliminated coverage for certain pregnant women and put enrollment for their children’s health care plan on hold. The state also attempted to eliminate coverage for lawfully present immigrants but the state ultimately continued the funding. The state funds some pregnancy services through tobacco taxes.

Medicaid Expansion Implementation: Colorado was one of several states to accept the option to expand Medicaid eligibility to childless adults prior to the Medicaid expansion. Beginning in 2012, those making less than about $1,089 became eligible for Medicaid. The state has explored legislative attempts to expand coverage through a Medicaid buy-in proposal as well as reduce enrollment through work requirements. The work requirement proposal failed in committee and the Medicaid buy-in proposal has not advanced.

General facts about Colorado Medicaid:

Medicaid program name: Health First Colorado

CHIP Program name: Child Health Plan Plus (CHP+)

Separate or combined CHIP: Combination

Medicaid Enrollment: 1.4 million (estimate 2017)

Total Medicaid Spending: $7.9 billion (FY 2016 estimate)

Share of total population covered by Medicaid: 19%

Share of Children covered by Medicaid: 40% (estimate)

Share of Medicaid that is Children and Adults: 80%

Share of Spending on Elderly and people with disabilities: 59%

Share of Nursing Facility Residents covered by Medicaid: 60% (estimate)

FMAP: 50%

Expansion state: Yes

Number of people in expansion: 425,500 (estimate)

Work Requirement: No

California Medicaid History and Facts

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Initial Medicaid Implementation: California implemented its Medicaid program on March 1, 1966, a year following the passage of the Medicaid program. The program was signed into law in November of 1965 by then Governor Pat Brown. In the first year of the program, Medicaid in California (known as Medi-Cal) enrolled nearly 1.2 million people. During the first year the program was being implemented, Ronald Reagan was running for California governor and would inherit the early implementation of the program.

Key Medicaid Political Issues: California was the first state to implement the PACE program in San Francisco’s Chinatown neighborhood, a program that would eventually became part of the Medicaid program. The state has been an early adopter in many other areas of Medicaid policy. The state was an early adopter of the Children’s Health Insurance Program and was the first state to implement a mobile application for Medicaid. The state has been active in extending coverage to both children and pregnant women and due to the diverse cultures of the state has been a leader in extending certain flexibilities in terms of language and cultural competencies. The state has consistently debated whether to extend Medi-Cal to undocumented Californians and currently provides ED coverage and coverage for undocumented children through the Medicaid program with the state incurring a large portion of that cost. California has consistently been criticized for the low payment rates to providers, having the lowest reimbursement rate to primary care physicians prior to the temporary increase in primary care payments as part of the Affordable Care Act.

Medicaid expansion Implementation: California’s governor, Jerry Brown, was one of the first governors to pledge to implement the Medicaid expansion following the 2012 Supreme Court decision. The expansion was officially signed into law on June 27, 2013. Starting in 2011, California took advantage of a provision of the Affordable Care Act that allowed states to expand Medicaid early to limited numbers of people. The state extended eligibility to approximately 250,000 individuals making under 200% of the federal poverty level. The state has had three major impediments to a successful implementation of their Medicaid program. Initially, the state had nearly one million applicants whose applications hadn’t been processed. Second, the state ended up enrolling approximately four million Californians that surpassed the state’s initial projections. The state utilized authorities to enroll people already eligible for food nutrition assistance and other programs. Additionally, an investigation found that in the initial years of implementation the state did not quickly unenroll some people who were no longer eligible for Medicaid expansion due to change in employment or other circumstances.

General facts about California Medicaid:

Medicaid program name: Medi-Cal

CHIP Program name: Healthy Families

Separate or combined CHIP: Combination

Medicaid Enrollment: 12,054,906 (April 2018)

Total Medicaid Spending: $81.96 billion (FY 2016)

Share of total population covered by Medicaid: 26%

Share of Children covered by Medicaid: 40% (estimate)

Share of Medicaid that is Children and Adults: 84%

Share of Spending on Elderly and people with disabilities: 60%

Share of Nursing Facility Residents covered by Medicaid: 60% (estimate)

FMAP: 50%

Expansion state: Yes

Number of people in expansion: 3.5 million (2016)

Work Requirement: No

Arizona Medicaid History and Facts

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Initial Medicaid Implementation: Arizona was the last state to take up the Medicaid program initially, beginning their program in October of 1982, 17 years after the passage of the law. Prior to accepting the Medicaid program, Arizona had a county-based system for providing care to low-income residents. This meant that the services available to low-income Arizonans varied greatly based on where they lived. The Medicaid program’s name the Arizona Health Care Cost Containment System (AHCCCS) illustrates the state’s early goals for the program. The state held out in part until they were able to secure the ability to implement their Medicaid program through managed care contracts. The state became the first and only state to run their Medicaid program entirely through capitated arrangements with contracted health plans. Today a small portion of beneficiaries, primarily elderly and disabled individuals requiring long-term care, obtain coverage outside of the managed care plans.

Key Medicaid Political Issues: Initially, the state only covered acute care services. In 1987 they began covering long-term care through a separate program called ALTCS. In the 1980s the state adopted expansions to the AHCCCS program to pregnant women and children and defund organ transplants. In the last few years, the state has had some unique policy debates surrounding the funding of the state’s Children’s Health Insurance Program. In 2010 the state froze enrollment in the KidsCare program and in 2014 discontinued the program. For two years the state was the only state without CHIP and the only state to discontinue a CHIP or other eligibility category of Medicaid. 

Medicaid expansion Implementation: Then governor Jan Brewer became one of the first Republican governors to accept the Medicaid expansion. The legislature passed the Medicaid expansion appropriation by a simple majority. Following the expansion, the legislature worked to sue the administration to end the expansion. The Arizona Supreme Court eventually struck down the lawsuit in 2017. The suit was centered on the fact that the state legislature did not pass the expansion with a 2/3rd majority that is required for to levy a tax on providers. The state applied for a Section 1115 waiver in August 2015. The program requires that enrollees earning more than the poverty level pay premiums into a health savings account or participate in wellness programs and offers an optional job search program. In 2018 the state has submitted a work requirement waiver to CMS which included several policies that were previously rejected by the Obama administration including a 6 month lockout period for non-payment, a 5 years lifetime limit on Medicaid coverage, 6 month redeterminations of coverage.

General facts about Arizona Medicaid:

Medicaid program name: Arizona Health Care Cost Containment System (AHCCCS)

CHIP Program name: KidsCare

Separate or combined CHIP: Separate CHIP

Enrollment: 1,700,000 (2017)

Total Medicaid Spending: $11.1 billion (2016)

Share of total population covered by Medicaid: 25.4% (estimate)

Share of Children covered by Medicaid: 50% (estimate)

Share of Medicaid that is Children and Adults: 81%

Share of Spending on Elderly and people with disabilities: 50%

Share of Nursing Facility Residents covered by Medicaid: 60% (estimate)

FMAP: 69.2%

Expansion state: Yes

Number of people in expansion: 418,400 (2016)

Work Requirement: Submitted

Arkansas Medicaid History and Facts

Initial Medicaid Implementation: The state set up a limited Medicaid program shortly after the passage of the act to pay for nursing home services. Arkansas established its Medicaid program in 1970. Wilbur Mills, the chief Congressman and Ways and Means Chairman that facilitated the passage of the Medicare Act of 1965 hailed from Arkansas.

Key Medicaid Political Issues: Arkansas has historically had the second most restrictive

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eligibility standards. The 1980’s were largely characterized by reductions in benefits and reimbursement rates in addition to further restrictions through prior authorizations and other barriers. In the 1990’s the state extended coverage to additional children and pregnant women. Throughout the 2000’s Medicaid provided a safety net during recessions but eligibility was very limited and coverage included extensive cost sharing. Prior to the passage of the Affordable Care Act, Arkansas Medicaid did not cover low-income, non-caretaker adults without disability or special condition. In comparison with many other states, the Medicaid program remains a small portion of the state’s budget

Medicaid expansion Implementation: Arkansas expanded Medicaid in April 2013 as part of a legislative compromise between the Republican dominated legislature and the Democratic governor, Mike Beebe. The state was the first to use an 1115 waiver in conjunction with their expansion to allow for premium assistance and the selection of marketplace plans for higher income enrollees. Since the initial implementation of the 1115 waiver the state has continued to add additional requirements to the Medicaid program and have made efforts to restrict eligibility in Medicaid expansion. In June of 2018 Arkansas it became the first state to implement the requirement that Medicaid beneficiaries to work to continue receiving benefits.

General facts about Arkansas Medicaid:

Medicaid program name: Medicaid

CHIP Program name: ARKids

Separate or combined CHIP: Combination

Enrollment: 912,000 (2017)

Total Medicaid Spending: $6 billion (2016)

Share of total population covered by Medicaid: 22%

Share of Children covered by Medicaid: 66%

Share of Medicaid that is Children and Adults: 73%

Share of Spending on Elderly and people with disabilities: 27%

Share of Nursing Facility Residents covered by Medicaid: 66% (estimate)

FMAP: 70.88%

Expansion state: Yes

Number of people in expansion: 303,900 (2016)

Work Requirement: In effect

Alabama Medicaid History and Facts

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Initial Medicaid Implementation: Alabama began exploration of formation of its Medicaid program through an executive order in 1967. The state didn’t begin enrolling people in Medicaid until January 1, 1970. On the first day of enrollment 253,991 Alabamans were deemed eligible for insurance.

Key Medicaid Political Issues: Within a year and a half of the program in effect, several services were discontinued due to the cost. First eyeglasses were discontinued, then provider reimbursements were lowered, hospital stays were reduced, and drug spending was reduced. Budget issues continue to be a focus of the Medicaid program in the state and was at the center of key budget discussions in 2015 and 2016.

Medicaid expansion Implementation: The state began “looking into” Medicaid expansion in November of 2015 under governor Bently. The state has not taken major action to expand Medicaid since the 2015 comments by the governor. The state has proposed work requirements for their existing Medicaid eligible population.

General facts about Alabama Medicaid:

Medicaid program name: Medicaid

CHIP Program name: ALL Kids

Separate or combined CHIP: Separate CHIP

Enrollment: 874,000 (2017)

Total Medicaid Spending: $5.461 billion (2016)

Share of total population covered by Medicaid: 21%

Share of Children covered by Medicaid: 40% (estimate)

Share of Medicaid that is Children and Adults: 68%

Share of Spending on Elderly and people with disabilities: 63%

Share of Nursing Facility Residents covered by Medicaid: 66% (estimate)

FMAP: 70.2%

Expansion state: No

Number of people in expansion: N/A

Work Requirement: Under consideration